JP4494188B2 - Variable Elevatorium - Google Patents

Description

  The present invention relates to an elevatrium used for a surgical operation, and more particularly to an elevatrium having a retractor function.

  In surgical operations, it is necessary to exclude surrounding tissues, soft tissues such as muscles and visceral tissues from the surgical field in order to secure a field of view of the surgical field and prevent damage to tissues around the surgical field. For this purpose, conventionally, a metal instrument (a retractor) having a shape in which one end is curved or bent is used. Specifically, the retractor is inserted into the incision from the incision wound edge, and the soft tissue is excluded from the surgical field and protected by the assistant pressing or pulling the rear end. However, in recent years, surgery using small incisions such as endoscopic surgery and minimally invasive surgery has been performed, and as a result, the surgical field has become narrower, and large retractors themselves have a surgical obstacle. It becomes.

  Therefore, a retractor particularly suitable for use in a small incision is required, and various retractors have been proposed for this purpose.

For example, in the technique disclosed in Patent Document 1 (Japanese Patent Application Laid-Open No. 6-154152), the distal end portion of the retractor is constituted by a plurality of flat plates, and is inserted into a small incision so that the organ can be opened inside. Exclude it. In the technique disclosed in Patent Document 2 (Japanese Patent Laid-Open No. 9-299374), a plurality of pressing rods are closed and inserted into the abdominal cavity through the small holes, and the pressing rods are expanded in the abdominal cavity to press the internal organs and the like. It is intended to ensure a mirror field of view.
Similarly, the technique disclosed in Patent Document 3 (Japanese Patent Laid-Open No. 2003-16459) opens and closes the seat, and the technique disclosed in Patent Document 4 (Japanese Patent Laid-Open No. 2002-360582) squeezes against elasticity. The relieved member is elastically restored and expanded in the abdominal cavity to relieve the organ and secure a surgical field.

  These retractable retractors have the advantage of reducing the number of retractors to be used by expanding the displacement area inside the small incision, but the open / close mechanism is complicated and difficult to handle in the event of a failure. Since various organs in the incision are mixed, opening and closing is performed, so that there is a risk that the internal organs may be pinched and damaged, or the expansion may not be sufficiently performed.

  Thus, conventionally, the improvement of the retractor for small incision has been made for the purpose of expanding the exclusion area. However, since the retractor is generally held down and supported by the hand, a heavy burden is placed on the assistant. Although a retractor is also fixed to an operating table etc., in this case, an exclusion site | part cannot be changed flexibly. Also, especially in surgery in the orthopedic field, Elevatorium and a retractor that lifts hard tissues such as bones and exfoliates the periosteum and muscles from the bone are used in combination with or after removal of Elevatorium. Later, the surgical field of view is secured by inserting and retracting the retractor to retract the soft tissue, but the number of retractors is limited when using the retractor while the elevator is inserted, and after using the elevator If a retractor is used instead, a quick operation is required for replacement. As described above, the conventional improved retractor does not sufficiently solve the problem in the small incisional surgery.

JP-A-6-154152 JP 9-299374 A JP 2003-16459 A JP 2002-360582 A

  SUMMARY OF THE INVENTION Accordingly, it is an object of the present invention to provide a surgical instrument that reduces the burden on an operator in a surgical operation, facilitates a surgical operation quickly, and minimizes the risk of damage to soft tissue.

  The present inventor conducted intensive research to solve the above-described problems related to the conventional retractor, and the elevatrium and the retractor function so as to be able to bend the elevatrium that has been widely used in the orthopedic field. The problem has been solved by having both.

Therefore, the present invention provides the following variable elebatium.
1. A variable levatorium that also functions as a retractor used as an auxiliary tool for surgical operations, and is inserted into the incision so as to secure a surgical field of view, and the direction of the rear end region does not obstruct the surgical field of view. A variable elevatrium that keeps the surgical field of view widened.
2. 2. The variable levatorium according to 1, wherein a detachable rigid mandrel is provided inside the variable range of the variable elevatrium, and is inserted into the incision in that state to secure a surgical field of view as an elebatium.
3. A detachable rigid mandrel is provided inside the variable region of the variable elebatrium, and inserted into the incision in that state to secure a surgical field of view as an evabatium, then the rigid mandrel is removed and the position of the rear end region is determined as a surgical field of view. 2. The variable levatorium as described in 1 above, wherein the surgical field of view is widened by changing in a direction that does not interfere with the operation.
4). Cross section serving as a retractor function, comprising a wound insertion portion (1) having a tapered tip, an intermediate portion (2) having a bending mechanism, and a gripping portion (3), which is used as an auxiliary tool for surgical operation Is a flat elevatrium, and the wound insertion part (1), intermediate part (2) and grasping part (3) are held in a straight line shape so as to be inserted into the wound during initial operation and to secure a surgical visual field. A variable elevatrium that is bent at the intermediate part (2) and holds the grip part (3) at a position that does not obstruct the surgical visual field during surgery.
5). The wound insertion part (1), the intermediate part (2) and the grip part (3) have a mandrel insertion hole (4) inside, and the mandrel (5) is inserted into the insertion hole (4) and fixed. 5. The variable levatorium as described in 4 above, which maintains a linear shape during operation.
6). The bending mechanism of the intermediate part (2) has at least two joint members (6) fitted to the rear end part of the wound insertion part (1) and the front end part of the grip part (3), and the joint 5. The variable levatorium as described in 4 above, wherein the member (6) has a structure in which the joint portion is not bent to one side of the flat plane and not bent to a predetermined angle or more on the other side when the member (6) is in a straight line state.
7). The wound insertion part (1), the intermediate part (2) and the gripping part (3) occupy a length of approximately 3: 1: 3 with respect to the total length of the variable evabatium, with respect to the total length of the variable levatorium 4. The variable elevatrium according to 4.
8). 7. The variable levatorium according to 6, wherein a bending angle on the other side of the flat surface by the at least two joint members (6) is 90 degrees at the maximum.
9. 5. The variable elevatrium described in 4 above, which is made of a hard metal material.
10. 10. The variable levatorium according to 9 above, wherein the hard metal material is a stainless steel material.
10. The variable levatorium according to 9 above, which has 11.2 joint members (6), and bending angles at three joint portions are each approximately 30 degrees.
12 5. The variable levatorium according to 4, wherein the distal end portion of the wound insertion portion (1) has an anchor structure for fixing the levatorium to the hard tissue.
13. 5. The variable levatorium as described in 4 above, wherein the grip portion (3) has a non-slip structure on the surface.
14 5. The variable levatorium according to 4 above, wherein at least the wound insertion portion (1) is covered with rubber or a flexible synthetic resin material.

  Since the variable elebatium of the present invention can be removed from the surrounding tissue just by pulling it as a fulcrum by hooking it to the hard tissue in the body after peeling the bone and muscle if necessary, etc. Compared to the type retractor, the burden on the surgeon (surgical assistant) supporting this is small. Moreover, after fulfilling the function as an elevatrium, it functions as a retractor without being replaced with a retractor, so that a soft tissue such as an organ can be operated quickly and easily without risk of damage.

Hereinafter, the variable levatorium of the present invention will be described together with its usage modes with reference to the drawings.
An example of the variable levatorium of the present invention is shown in FIG. 1 (front view) and FIG. 2 (sectional view cut along SS ′ in FIG. 1). This variable elevatrium is basically configured by connecting three members of the wound insertion portion (1), the intermediate portion (2) and the gripping portion (3), and a mandrel insertion hole is formed inside these three members. (4) is provided, and by inserting and penetrating a mandrel (5) made of a hard material, the above members are maintained in a linear form. 1 and 2, the state before the mandrel is inserted is shown as (A), and the state where the mandrel is inserted is shown as (B). The mandrel insertion hole (4) is shown only in its opening in the figure, but as shown in FIGS. 1 (B) and 2 (B), the mandrel should be formed so as to be fixed through the three members. The shape is not particularly limited. An example of the mandrel is shown in FIG.

  The shape of the variable levatorium may be substantially the same as that of a conventional levatorium except for the intermediate portion (2). That is, the wound insertion portion (1) has a tapered tip and is formed flat as a whole. In particular, the tip portion has a curved structure in order to perform an anchor function to hard tissue. Moreover, in the aspect shown in FIG. 1, although the wound insertion part (1) is made into the shape which has one point, the front-end | tip may be branched into plurality. By adopting these structures, the anchoring property to the hard tissue when functioning as a retractor is enhanced, and it becomes easier to separate the periosteum and muscle from the bone as Elevatorium. As shown in FIG. 2, the thickness of the wound insertion portion (1) may be partially increased to reinforce the strength.

  The gripping part (3) is the same and may have the same shape as the gripping part of a conventional Elevatorium. Preferably, a slip stopper such as a longitudinal groove or a lateral groove is provided on the surface. As described above, the mandrel insertion hole (4) is opened at the rear end of the gripping part (3), and the opening is preferably threaded to form the rear end (51; So that the mandrel (5) does not fall out of the variable levatorium during the operation as the levatorium.

  The intermediate part (2) consists of one or more joint members. 1 and 2 show an example constituted by two joint members (6a, 6b).

  The connection between these joint members (6a, 6b) and the connection mechanism between the wound insertion portion (1) or gripping portion (3) and these joint members (6a, 6b) are basically the same. Any connecting structure that can be bent can be used. For example, as shown in FIG. 2 (straight state) and FIG. 4 (bent state), the joint member (6a) has a cylindrical protrusion (protrusion having a substantially circular cross section) on the side adjacent to the wound insertion portion (1). (21a) is provided, and a groove having a circular cross section is provided on the side of the joint member (6a) of the wound insertion portion (1) so as to receive the cylindrical protrusion. By engaging the cylindrical protrusion (protrusion having a substantially circular cross section) (21a) with the groove, both are freely bent. Similarly, a groove having a circular cross section is provided on the joint member (6b) side of the joint member (6a), and a cylindrical protrusion (on the joint member (6a) side of the joint member (6b) so as to fit the groove. 21b) is provided to engage both. Similarly, a groove having a circular cross section is provided on the gripping part (3) side of the joint member (6b), and a cylindrical protrusion (31) is provided on the joint member (6b) side of the gripping part (3). Engage. Thus, three connecting portions are formed from the wound insertion portion (1) to the grasping portion (3) (the same applies when the number of joint members is three or more).

  The cylindrical protrusions (21a, 21b, 31) are rotatable inside the corresponding grooves, thereby realizing bending at the intermediate portion (2). In addition, it is necessary that the assistant's hand holding the variable elevatrium during the operation does not interfere with the view of the operator. For this purpose, the bending angle at the intermediate portion (2) (the insertion portion (1) in the wound) And the gripping part (3) —see FIG. 4) preferably form an angle of about 90 degrees.

The limit of bending at each connecting portion is the clearance between the corners surrounding the grooves of each member and the corresponding shoulder of the adjacent member (supporting the cylindrical protrusion) to the shoulder of the neck (notch-shaped gap in FIG. 2 etc.) Depending on the size of the width. That is, when the intermediate portion (2) is bent, the shoulder portion of the cylindrical protrusion comes into contact with the corner portion at a certain point, and does not bend any more (see FIG. 4. The protrusion 21a will be described later). The members are omitted). Therefore, the bending angle in the intermediate portion (2) is determined by the size of these clearances and the number of joint members.
For example, when the bending angle is 90 degrees, the bending angles between the wound insertion portion (1), the joint member (6a), the joint member (6b), and the gripping portion (3) are each set to a maximum of 30 degrees. Good.

  The clearance is preferably asymmetric between the front and back surfaces of the variable elebatium. For example, in FIG. 2, the clearance is almost zero on the front surface side of the variable elebatium, and has a large clearance on the back surface side. For this reason, the variable elebatium bends on the back side but does not bend on the front side. By adopting such a configuration, when pulling out the variable evalatorium from the wound, if the gripping part (3) is tilted to the surface side, the variable evalatium becomes rigid from a certain point (when the whole is linear). The anchor at the distal end of the wound insertion portion (1) can be easily removed.

A faint structure (7) may be provided between the joints. This is, for example, a member provided on the outer surface so as to cover the gap causing the clearance, and each of the wound insertion portion (1), the joint member (6a), the joint member (6b), and the gripping portion (3). Connect between the two. Both ends of the faint member (7) are fixed to each member to which it is connected. Fixing can be performed by adhesion, fusion, brazing, nailing or the like. The rinse member (7) is, for example, a sheet or string-like member formed of rubber or stretchable synthetic resin. Or it is also possible to make a faint member into a cyclic | annular member, penetrate each member, and to carry out connection connection in the shape of a chain | strand.
By providing such a rinse structure, the load applied to the joint portion at the time of bending can be reduced, and the soft tissue to be squeezed out can be prevented from being caught or damaged in the gap portion.

  In addition, said example is an example of the variable levatorium of this invention, Comprising: The number of joint members and a bending angle can be changed arbitrarily. For example, the structure of the joint portion can be changed or modified in various ways. For example, the protrusion and the groove have a direction opposite to that shown in FIG. 2 (that is, the insertion portion (1) has a protrusion and the adjacent joint portion has this protrusion). In the same manner, the holding portion (3) has a groove for receiving the projection of the joint portion.

  The material of each part and the mandrel (5) is arbitrary as long as it is suitable for the purpose of the present invention, but is made of a hard metal material (for example, stainless steel) or hard plastic that is not toxic or allergenic to the living body. Is preferred. Moreover, it is preferable to coat rubber or a soft and insulating synthetic resin on a portion of the wound insertion portion (1) that comes into contact with a soft tissue such as skin or organ. In this way, it is possible to prevent burns due to energization when using an electric knife without damaging the skin or soft tissue. Moreover, in FIGS. 1-2, although the example which a mandrel penetrates to the upper part of the wound insertion part (1) was shown, the penetration length (depth) of a mandrel is the wound insertion part (1), It is optional as long as the intermediate part (2) and the grip part (3) are sufficiently fixed. Therefore, the mandrel may be penetrated longer (deeper) into the wound insertion portion (1).

  In addition, the size and shape of the variable levatorium of the present invention are determined according to the surgical site. Generally, the total length (the length from the distal end of the insertion portion to the rear end of the gripping portion) is about 100 to 300 mm, and the width of the gripping portion is an appropriate size for gripping by hand, for example, about 10 to 30 mm. The thickness is preferably about 13 to 20 mm, and the thickness is about 5 to 15 mm, preferably about 10 mm. The mandrel is usually about 1.5 to 5 mm, preferably around 3 mm, and the mandrel insertion hole should be slightly larger depending on the mandrel. For example, if the mandrel has a diameter of 3 mm, it should be 3.5 mm or more. is there. Furthermore, the ratio of the wound insertion portion: intermediate portion: gripping portion can be arbitrarily designed, but the length of the wound insertion portion and the gripping portion is usually about 1 to 4 times the length of the intermediate portion. The ratio is preferably about (for example, wound insertion portion: intermediate portion: gripping portion = 1: 3: 1).

The variable elebatium of the present invention is used as follows.
In the initial operation of the operation, the three members of the wound insertion portion (1), the intermediate portion (2), and the grip portion (3) are formed in a linear form, and the mandrel (5) is passed through the mandrel insertion hole (4), and the screw These members are held in a linear form by stopping. In this state, the variable elebatium is rigid, so it can be easily inserted into the wound, and if necessary, it can be operated as an elebatium, such as lifting hard tissues such as bones or peeling bones from membranes and muscles. It can be performed.

  Next, the mandrel (5) is extracted from the variable elevatrium. As described above, at this stage, the variable elebatium is in a state where the intermediate portion (2) can be bent. Therefore, if the variable elebatium is pulled in the direction of opening the small incision with the grasping portion (3), the soft tissue is excluded and the visual field of the surgical field is secured. That is, in accordance with the bending operation, it functions as a retractor that excludes, pulls, and protects soft tissues such as muscles and internal organs while ensuring a surgical visual field in the wound insertion portion (1).

  At the end of the surgery, the variable levatorium of the present invention can be easily pulled out of the wound by tilting the variable elebatium in the opposite direction to that during traction and releasing the anchoring to the hard tissue. At the same time, the soft tissue exclusion traction is also released.

  The variable elebatium of the present invention can be widely used in surgery in a site including hard tissue, and is particularly useful as an auxiliary tool for a surgical operation performed on a small incision.

It is a front view which shows the embodiment of the variable levatorium of this invention, (A) shows the state after insertion, (B) shows the mandrel insertion. It is the side side view which cut | disconnected the variable levatorium of FIG. 1 by S-S ', (A) shows the state after insertion, (B) before the mandrel insertion. The side view which shows an example of the mandrel of this invention. The typical sectional view showing the bending state of the middle part of the variable type evabatorium of the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Wound insertion part 4 Mandrel insertion hole 2 Middle part 21a Cylindrical protrusion 21b Cylindrical protrusion 3 Holding part 31 Cylindrical protrusion 4 Mandrel insertion hole 5 Mandrel 51 Rear end part 52 Lid 6a Joint member 6b Joint member 7 Shaking member

Claims (15)

A variable type elebatium that also serves as a retractor used as an auxiliary tool for surgical operations, and is inserted into the incision wound as an elebatium in a straight and rigid form to secure the surgical visual field, and then the position of the rear end region Is a variable elevatrium that keeps the surgical field of view widened by changing it in a direction that does not obstruct the surgical field of view.   2. The variable levatorium according to claim 1, further comprising a detachable rigid mandrel inside the variable range of the variable elebatium, and inserted in the incision in that state to secure a surgical field of view as an elebatium.   A detachable rigid mandrel is provided inside the variable area of the variable elebatium, and after insertion into the incision wound to secure a surgical field of view as an evabatium, the rigid mandrel is removed and the position of the rear end region is determined as a surgical field of view. The variable levatorium according to claim 1, wherein the surgical field of view is expanded by changing the direction in a direction that does not disturb the operation.   A variable elevatrium that also serves as a retractor function and is used as an auxiliary tool for surgical operations. It has a mandrel insertion hole (4) inside, and a rigid mandrel (5) is inserted into the insertion hole (4) during initial operation. Then, after inserting into the incision wound in a linearly fixed state and securing the surgical visual field as elebatium, the rigid mandrel is removed and the position of the rear end region is changed in a direction that does not interfere with the surgical visual field. A variable elevatrium that keeps the door in an expanded state.   Cross section serving as a retractor function, comprising a wound insertion portion (1) having a tapered tip, an intermediate portion (2) having a bending mechanism, and a gripping portion (3), which is used as an auxiliary tool for surgical operation Is a flat elevatrium, and the wound insertion part (1), intermediate part (2) and grasping part (3) are held in a straight line shape so as to be inserted into the wound during initial operation and to secure a surgical visual field. A variable elevatrium that is bent at the intermediate part (2) and holds the grip part (3) at a position that does not obstruct the surgical visual field during surgery. The wound insertion part (1), the intermediate part (2) and the grip part (3) have a mandrel insertion hole (4) inside, and the mandrel (5) is inserted into the insertion hole (4) and fixed. 6. The variable levatorium according to claim 5, which retains a linear shape during operation. The bending mechanism of the intermediate part (2) has at least two joint members (6) fitted to the rear end part of the wound insertion part (1) and the front end part of the grip part (3), and the joint 6. The variable levatorium according to claim 5, wherein the member (6) has a structure in which the joint portion does not bend on one side of the flat surface and does not bend more than a predetermined angle on the other side when the member (6) is in a straight line state. The wound insertion part (1), the intermediate part (2) and the grip part (3) each occupy a length of about 3: 1: 3 with respect to the total length of the variable evabatorium. Item 6. The variable levatorium according to Item 5 . The variable levatorium according to claim 7 , wherein a bending angle on the other side of the flat surface by the at least two joint members (6) is 90 degrees at the maximum. 6. The variable levatorium according to claim 5, comprising a hard metal material. 11. The variable levatorium according to claim 10 , wherein the hard metal material is a stainless steel material. The variable type levatorium according to claim 7 , comprising two joint members (6), and bending angles at three joint portions are approximately 30 degrees, respectively. The variable type evabatorium according to claim 5 , wherein the distal end portion of the wound insertion portion (1) has an anchor structure for fixing the elebatium to the hard tissue. The variable levatorium according to claim 5, which has a non-slip structure on the surface of the grip portion (3). 6. The variable levatorium according to claim 5, wherein at least the wound insertion part (1) is coated with rubber or a flexible synthetic resin material.

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